The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting.
|
|
- Maurice Horton
- 6 years ago
- Views:
Transcription
1 The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting. { Thalia Petropoulou, Clinical Fellow Paul Hainsworth,Colorectal Surgeon Prof Alan Horgan,Colorectal Surgeon Freeman Hospital, NUTH
2 Enhanced Recovery: the evidence Hospital stay ERAS vs Traditional days ERAS versus Traditional Care in Colorectal Surgery 13 Studies, 1910 patients Total complications 0.71 RR Readmission rate Mortality No difference Zhuang et al, DCR 2013
3 ERAS The Evidence Increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome (ERAS Compliance Group, Ann Surg Jun;261(6): Accelerated discharge within 72 hours of elective colorectal resection for cancer is safely achievable for the majority of patients without compromising short-term outcome (Emmanuel et al, Ann R Coll Surg Engl )
4 In this large, multi-institutional North American data registry, high adherence to ERPs was associated with earlier recovery, decreased complications, and shorter LOS. ERPs can improve outcomes; however, benefits correlate with adherence. Adherence to Enhanced Recovery Protocols in NSQIP and Association With Colectomy Outcomes (Berian et al, Annals of Surgery 23 October, 2017) 8139 elective colectomies at 113 hospitals { LOS 4.3 days (high adherence) vs 7.8 days low adherence; P < ). High-adherence patients achieved recovery milestones earlier (with return of bowel function at 1.9 (vs 3.7) days, tolerance of diet at 2.4 (vs 5.4) days, and oral pain control at 2.7 (vs 5.0) days (P < )
5 Prolonged Postoperative Ileus (PPOI) PPOI remains a significant clinical problem in patients undergoing advanced pelvic cancer surgery (about 30%), despite the increased awareness and implementation of enhanced recovery protocols. New regimens for better prophylaxis are needed, and further research on POI treatment is important. (Funder et al, J Surg Res Oct;218: ) Prolonged ileus is a common condition following colon resection, with an incidence of 12.7% and its worst in right sided colectomies- NSQIP databases total of 27,560 patients (Moghadamyeghaneh et al, Surg Endosc Feb;30(2):603-9
6 Methods to reduce POI Methods to prevent-reduce POI are needed (ERAS Society World J Surg (2013) 37: , SAGES-ASCRS Diseases of Colon and Rectum Volume 60: 8 (2017)) Intraoperative optimazation and reduce opioids regular diet immediately Alvimopan Chewing gum Laxatives
7 Laxatives Bulking agents Stimulant agents Osmotic agents Stool softeners Used for stimulate gut motility and reduce constipation(1) Use in chronic constipation and in opiod induced constipation(2) Use in eras protocols to stimulate gut motility and reduce LOS 1(MedGenMed. 2007; 9(2): 25, Review of the Treatment Options for Chronic Constipation, John F. Johanson) 2. (BMJ Clin Evid Apr 6;2010. pii: 2407, Constipation in people prescribed opioids, Ahmedzai SH, Boland J )
8 Laxatives can reduse the length of hospital stay in colorectal surgery as and in non colorectal surgery Gianpiero Gravante and Muhammad Elmussareh World J Gastroenterol Jan 21; 18(3):
9 Laxatives and LOS- The evidence * Management of postoperative constipation in anorectal surgery. (Dis Colon Rectum Apr;22(3):149-51, Corman ML et al. -> Laxatives help with post-op constipation *Bowel function after minimally invasive urogynecologic surgery (improves with docusate sodium) : a prospective randomized controlled trial. (Female Pelvic Med Reconstr Surg 2012, Mar-Apr:18(2)82-85 McNanley A1, Perevich M, Glantz C, Duecy EE, Flynn MK, Buchsbaum G)
10 Laxatives and effect on LOS Bisacodyl in radical hysterectomy can reduce LOS of 1day (Ramiraz et al, World J Surg 2013, 37: Role of magnesium salts in early normalisation of gut motility after hepatic resection-> 1 day reduction of LOS (Basse L et al, BJS 2001, 88:
11 Laxatives and stimulation of gut motility- The evidence Reduce of constipation with lactulose, docusate and senna, without increasing side effects (Can Oncol Nurs J Autumn;23(4):236-46) Efficacy and side-effect profiles of lactulose, docusate sodium, and sennosides compared to PEG in opioid-induced constipation: a systematic review. Ruston T, Hunter K, Cummings G, Lazarescu A
12 Laxatives and stimulation of gut motility- The evidence *Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations (World J Surg (2013) 37: ) Prevention of postoperative ileus (including use of postoperative laxatives) Evidence level (chewing gum, alvimopan, laxatives (magnesium): Medium/ Low Recomedation grade: Weak *Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (DISEASES OF THE COLON & RECTUM VOLUME 60: 8 (2017) - Alvimopan and chewing gum: Recommendation 1A
13 Our Study Prospective observational study Includes all patients undergoing elective uncomplicated, colorectal resections, without stoma formation between 08/15 to 08/17. Hypothesis: use of laxatives could reduce the LOS without increasing complications 2 groups. 100 pts in group A, 120 patients in Group B Pre and intraoperative management was the same for both groups Postoperative, in group A we added the use of laxatives (docusate 100 mg BD) from post day 1. No laxatives in group B Primary end point was the LoS in each group. Secondary end point was the post-operative complication rate. Pt with complications excluded from the analysis of LoS
14 Intra-op Pre-op Post-op Remove urinary catheter OUT ON DAY 1 UNLESS RECTAL SURGERY (day 2) The protocol Antibiotics prophylaxis No premedication Anesthesia protocols Laparoscopic surgery Active warming Perioperative fluid management Control blood glucose PONV prophylaxis Thromboprophylaxis Education and counselling Nutritional assessment and support Cardiopulmonary function evaluation No bowel preparation Drink clear fluids till 2 hrs pre op Carbohydrate drinks No nasogastric tube UNLESS NECESSARY Prevention of stress ulcer Omeprazole 20 mg Multimodal analgesic approaches Paracetamol 1 gr TDS Ivuprofen 400 mg TDS, 200 mg PRN (max 2400 mg) Tramadol 100 mg PRN PCA (Yes/No) OUT ON DAY 1-2 IN LAP OR 3 IN OPEN Epidurall (Yes/No) OUT ON DAY 1-2 IN LAP OR 3 IN OPEN Early oral intak Oral Fluid (mls in 24 hours) Nutritional support Two high protein/ calorie drinks on operation day Three high protein/ calorie drinks per day from post-op days 1 to 3 Early Mobilisation/Time out of Bed (hrs in 24 hrs) Prevent of PONV cyclizine ondacentron Stimulate of gut motility Laxido (Yes/No) COMMENCE ON DAY 1 Remove drain tubes Stop IVT Day 1
15 Group A Lap Right Lap Left Open Stoma
16 Group B Lap Right Lap left Open Stoma
17 { { Group A 100 patients overall median LOS was 4 days (range 2-6) lap right resections 3 days lap left sided resections 4 days open/complicated resections, 6 days Group B 120 patients overall median LOS was 5 days (range 2-7) lap right resections 5 days lap left sided resections 5 days open/complicated resections, 6 days Statistically significant difference in LoS was found in all subgroup analysis (p<0,001), except the open/complicated resections (p=.931)
18 Results The complication rate was 16% for the first group and 18,3% for the second group, but this was not significantly different between groups (p=.64)
19 Type of surgery Lap Left Sided Colectomies Lap Right Sided Colectomies Open/ Complicated Resections All Resections Complicatio n Rate (%) Group A (100 pts) LOSH (Days- Mediam) Group B (120 pts) LOSH (Days- Mediam) P- Value (Mann- Whitney U test) 4 5 < < < < (x square test)
20 Results 8 pts from Group A went home on post-op day 2 No one from Group B went home on post-op day 2 No pts from Group A, went home on day 7 6% PPOI in Group A VS 15% in Group B
21 Conclusions * Use of laxatives from the first post-operative day, may be a safe and effective measure to reduce LoS in patients undergoing uncomplicated elective colorectal surgery, without stoma formation The reduce in LOS is greater in pts undergoing right sided resections No evidence to suggest that their use can affect anastomotic dehiscence * Further studies and RCT s are necessary in order to establish their use and gain the benefits
22 Thank you
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus
More informationOperational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy
Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Conor P. Delaney MD MCh PhD Chairman, Digestive Disease Institute Professor of Surgery, Cleveland, Ohio Disclosure Slide Conor Delaney MD PhD
More informationERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic
ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track
More informationEnhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid
More informationR Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,
More informationLaparoscopic Colorectal Surgery
Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment
More informationANICOLAU.RO. Enhanced Recovery after Colorectal Surgery. Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist*
Enhanced Recovery after Colorectal Surgery Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist* Clinical Emergency Hospital of Bucharest, Romania *Karolinska Institute, Stockholm, Sweden ERAS - Enhanced
More information7/31/2015. Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice. Objectives. Enhanced Recovery Society
Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice Margaret Odhner MS, ANP-BC, COCN Kim Meacham, MSN FNP-C, CWON Objectives 1. Describe the Enhanced Recover After Surgery (ERAS) pathway.
More informationGastrointestinal Feedings Post Op: What s the deal on beginning oral feedings?
Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings? Kate Willcutts, DCN, RD, CNSC University of Virginia Health System Charlottesville, VA kfw3w@virginia.edu Objectives 1. Discuss
More informationChirurgia del Colon in Week Surgery?
Chirurgia del Colon in Week Surgery? dr. V. Fiscon dr. G. Portale Chir. Generale, Cittadella -PD- ULSS 6 Euganea E il colon??? Kraft K et al., J C Visc 2013 Discharge early Colon in week surgery Readiness
More informationENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY
Department of Surgery Divison of General Surgery ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY December 2016 Disclosure Paresh
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationSimone Targa. Impact of an ERAS Colorectal Program on clinical outcomes and costs
Impact of an ERAS Colorectal Program on clinical outcomes and costs Simone Targa U.O. di Clinica Chirurgica Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna ERAS Protocol ENHANCED RECOVERY
More informationEnhanced Recovery after Surgery
Enhanced Recovery after Surgery AKA ERAS What is Enhanced Recovery (ER)? Paradigm shift in surgery and surgical care of the patient Philosophy of care Perioperative continuum Multidisciplinary Patient
More informationMultimodal Approach for Managing Postoperative Ileus: Role of Health- System Pharmacists (ACPE program H01P)
1. In the normal gastrointestinal tract, what percent of nutrient absorption occurs in the jejunum? a. 20%. b. 40%. c. 70%. d. 90%. 2. According to Dr. Erstad, the four components of gastrointestinal control
More informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.6 Facilitating Oral or Enteral Nutrition in the Postoperative Period Mattias Soop Learning Objectives To review the causes of postoperative
More informationANICOLAU.RO. What is ERAS? Enhanced Recovery After Surgery. A.E.Nicolau*,Irina Grecu** Spitalul Clinic de Urgenta
Spitalul Clinic de Urgenta ANICOLAU.RO What is ERAS? Enhanced Recovery After Surgery A.E.Nicolau*,Irina Grecu** *Clinica de Chirurgie **Clinica de Anestezie Terapie Intensiva ERAS = Fast-track surgery
More informationIf you reduce variability in volume administration, HOW. you can reduce post-surgical complications, LOS and associated costs 1-4
A large body of clinical evidence* demonstrates If you reduce variability in volume administration, you can reduce post-surgical complications, LOS and associated costs 1-4 Complications Too Dry Too Wet
More informationFluid Balance in an Enhanced Recovery Pathway. Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017
Fluid Balance in an Enhanced Recovery Pathway Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017 No Disclosures 2 Introduction The optimal intravenous fluid regimen
More informationEnhanced Recovery After Surgery Getting it Right
Enhanced Recovery After Surgery Getting it Right Aalok Agarwala, M.D., M.B.A. Division Chief, General Surgery Anesthesia Associate Director, Quality and Safety, MGH DACCPM Assistant Professor, Harvard
More informationEducational Learning Objectives. Evidence into Practice. Audience. Case Presentation. Outline. Multimodal Approach to Colorectal Surgery
Educational Learning Objectives Multimodal Approach to Colorectal Surgery Value and Impact of Nutrition Interventions May 5, 2011 Dr. Corilee A. Watters, MSc, RD, PhD, CNSC Asst. Prof, Nutrition, University
More informationCreating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination
Creating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination Jason D. Sciarretta, MD, FACS Grand Strand Medical Center, Myrtle Beach, SC University of South Carolina
More informationOptimising Perioperative Pain Management And Surgical Outcomes
Optimising Perioperative Pain Management And Surgical Outcomes Dr Chew Ghee Kheng MBBS FRCOG MD FAMS Senior Consultant Gynaecologist Subspecialist in Gynaecology Oncology Surgery Singapore General Hospital
More informationFast-Track Colonic Surgery: Status and Perspectives
Fast-Track Colonic Surgery: Status and Perspectives Henrik Kehlet H. Kehlet ( ) Section for Surgical Pathophysiology, Rigshospitalet, Section 4074, Blegdamsvej 9, 2100 Copenhagen, Denmark e-mail: henrik.kehlet@rh.dk
More informationEnhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience
Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC Our Data Experience No Disclosures 1/26/2015 2 Purpose To tell our story of how we collect and share our ERACS data 1/26/2015
More informationRandomized Controlled Trial of Bisacodyl Suppository Versus Placebo for Postoperative Ileus After Elective Colectomy for Colon Cancer
Original Article Randomized Controlled Trial of Bisacodyl Suppository Versus Placebo for Postoperative Ileus After Elective Colectomy for Colon Cancer Sukanya Wiriyakosol, Youwanuch Kongdan, Chakrapan
More informationPostoperative Ileus. UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011
Postoperative Ileus UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Hobart W. Harris, MD, MPH Introduction Pathophysiology Clinical Research Management Summary Postoperative Ileus:
More informationERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationPerceptions of the application of fast-track surgical principles by general surgeons
The Royal College of Surgeons of England AUDIT doi 10.1308/003588406X94940 Perceptions of the application of fast-track surgical principles by general surgeons CATHERINE JANE WALTER, ADRIAN SMITH, PIERRE
More informationDisclosures. I am a paid consultant for:
Surgical Sub-specialization: Colorectal Specialist Peter W. Marcello, M.D. Vice Chairman, Department of Colon & Rectal Surgery Lahey Clinic Burlington, Massachusetts Disclosures I am a paid consultant
More informationPrevent gastric distention and vomiting after surgery
Remove toxic and unwanted substances from the stomach Administration of enteral nutrition, drugs and so on It favors lung expansion in mechanically unconscious and ventilated subjects Aspiration gastric
More informationTAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial
TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial Kim Gorissen Frederic Ris Martijn Gosselink Ian Lindsey Dept of Colorectal Surgery Dept of
More informationTo staple or to sew. Zeng Xuan Hu
To staple or to sew Zeng Xuan Hu Fast Track Surgery Multimodal Rehabilitation Accelerated recovery Accelerated rehabilitation Enhanced recovery Optimize perioperative care by reducing the expected stress
More informationWelcome Charles Kennedy
Welcome Charles Kennedy Comoderators Girish P. Joshi, MBBS, MD, FFARCI Professor of Anesthesiology and Pain Management University of Texas Southwestern Medical Center Dallas, Texas David E. Beck, MD, FACS
More informationIndex. Enhanced Recovery in NSQIP (ERIN), 240 Epidural analgesia, 149 Epidural-induced hypotension (EIH) management, ERAS
A Abdominal surgery ERP carbohydrate treatment, 46 comprehensive guide, 258 crystalloid-based perioperative fluid therapy, 120, 122 insulin resistance, 64, 169 laparoscopic order sets, 269, 274 278 laparoscopic
More informationThirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children
Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children Jeremy D. Kauffman MD, Paul D. Danielson MD, Nicole M. Chandler MD Johns Hopkins All Children s
More informationPresentation at ACS NSQIP National Conference in July Surgical Site Infection Reduction Strategies
Presentation at ACS NSQIP National Conference in July 2015 Surgical Site Infection Reduction Strategies PeaceHealth Sacred Heart Medical Center at RiverBend Level II Trauma Center 379 Beds 15,060 cases
More informationDisclosures. Personalized Approaches to Gastrointestinal Cancers. Objectives. What is personalized cancer care. Go through some genomic studies
Personalized Approaches to Gastrointestinal Cancers Emily Groves, MD Colorectal Surgery Assistant Professor, Division of Surgical Oncology Disclosures None Objectives What is personalized medicine and
More informationImproving Colectomy Outcomes in the Enhanced Recovery In NSQIP (ERIN) Pilot
Improving Colectomy Outcomes in the Enhanced Recovery In NSQIP (ERIN) Pilot Julia R. BerianMD; Kristen A. Ban MD; Sanjay MohantyMD,MS; Jennifer L. ParuchMD,MS; Clifford Y. KoMD,MS,MSHS; Julie K. Thacker
More informationIdentifying Characteristics Associated with Ileus Development Post Coronary Artery Bypass Graft Surgery
University of Nebraska Medical Center DigitalCommons@UNMC Theses & Dissertations Graduate Studies Summer 8-19-2016 Identifying Characteristics Associated with Ileus Development Post Coronary Artery Bypass
More informationEnhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational study
Research Journal of the Royal Society of Medicine Open; 2015, Vol. 6(2) 1 5 DOI: 10.1177/2054270414562983 Enhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational
More informationAntidiarrheals Antidiarrheal
Antidiarrheals Major factors in diarrhea Increased motility of the GI tract. Decreased absorption of fluid. Antidiarrheal drugs include: Antimotility agents. Adsorbents. Drugs that modify fluid and electrolyte
More informationColorectal Surgery in the Elderly. Stephen Smith
Colorectal Surgery in the Elderly Stephen Smith Scope WHO >65 Social definition No COI Age specific incidence of CRC in Australia 2016 (new cases/100,000) My data: elective bowel resections
More information1 of 5. Integrated Order Set Inpatient, Adult. Gynecological Surgery Enhanced Recovery Orders apply to patients 18 years and older.
Orders apply to patients 18 years and older. All preprinted doses are based on normal renal and hepatic function and must be assessed for adjustment against the individual patient s renal and hepatic function
More informationESPEN Congress Vienna Nutrition after discharge from hospital: The surgeon s responsability. O. Ljungqvist (Sweden)
ESPEN Congress Vienna 2009 Nutrition after discharge from hospital: The surgeon s responsability O. Ljungqvist (Sweden) Nutrition after discharge from hospital: The surgeon s responsability Olle Ljungqvist
More informationDevelopment and Utilization of Standardized Hip Fracture Guidelines
Development and Utilization of Standardized Hip Fracture Guidelines Sally Knight RN Clinical Quality Nurse Lori Smith RN Clinical Quality Nurse Deborah Newall RN Orthopedic Program Coordinator Wallace
More informationIntro Who should read this document 2 Key practice points 2 What is new in this version 3 Background 3 Guideline Subsection headings
Enhanced Recovery for Major Urology and Gynaecological Classification: Clinical Guideline Lead Author: Dr Dominic O Connor Additional author(s): Jane Kingham Authors Division: Anaesthesia Unique ID: DDCAna3(12)
More informationEvaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University Hospital
Med. J. Cairo Univ., Vol. 85, No. 5, September: 1911-1916, 2017 www.medicaljournalofcairouniversity.net Evaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University
More informationLaparoscopic vs Robotic Rectal Cancer Surgery: Making it better!
Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better! Francis Seow- Choen Medical Director Seow-Choen Colorectal Centre Singapore In all situations: We have to use the right tool for the job
More informationEnhanced Recovery After Discharge: does it happen?
Enhanced Recovery After Discharge: does it happen? Nader K Francis ERAS-UK Southampton 14 th November 2014 BJS 2014 Functional / symptoms Length of hospital stay 37 Readmission 29 Pain 16 Fatigue 9 BJS
More informationEarly Recovery after Surgery (ERAS):
Early Recovery after Surgery (ERAS): Applying Consistently What We ve Known for 20 Years Dr. Kurt Heiss, MD Objectives Laying Foundation: Who, Why Explore Components: What Start a Program: How and When
More informationOriginal article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic and open surgery?
Gastroenterology Report 1 (2013) 138 143, doi:10.1093/gastro/got008 Advance access publication 4 April 2013 Original article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic
More informationEMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES
EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES Clifford Ko, MD, MS, MSHS, FACS, FASCRS Professor of Surgery UCLA Director, ACS NSQIP, American College of Surgeons EVIDENCE Ban
More informationERAS Protocol: Pancreatic Surgery
ERAS Protocol: Pancreatic Surgery PANCREATICODUODENECTOMY Versione del protocollo: giugno 2012 Team Coordinatore: Ospedale San Raffaele Milano Referenti: Chirurgo Dr. Gianpaolo Balzano e-mail: balzano.gianpaolo@hsr.it
More informationDIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV
DIVERTICULAR DISEASE Dr. Irina Murray Casanova PGY IV Diverticular Disease Colonoscopy Abdpelvic CT Scan Surgical Indications Overall, approximately 20% of patients with diverticulitis require surgical
More informationNerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS
Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV
More informationVincent James Obias, MD MS
Vincent James Obias, MD MS Education Undergraduate B.S., James Madison University, 1989-1993 Graduate/Medical Education Masters of Science, Medical College of Virginia/Virginia Commonwealth University,
More informationImpact of a Pharmacist Implemented Protocol on Overall Use of Alvimopan (Entereg ) and Length of Stay in Laparoscopic Colorectal Surgeries
Journal of Pharmacy and Pharmacology 4 (2016) 521-525 doi: 10.17265/2328-2150/2016.10.001 D DAVID PUBLISHING Impact of a Pharmacist Implemented Protocol on Overall Use of Alvimopan (Entereg ) and Length
More informationThe Binational Colorectal Cancer Audit. A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017
The Binational Colorectal Cancer Audit A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017 Binational Colorectal Cancer Database 2010 First Patient 2011 Contract between CMUDS and
More informationFast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery
12 Fast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery L Ndayizeye, A K Kiswezi University Teaching Hospital of Butare, Rwanda. Correspondence
More informationFAST TRACK MANAGEMENT OF PANCREATIC CANCER
FAST TRACK MANAGEMENT OF PANCREATIC CANCER Jawad Ahmad Consultant Hepatobiliary Surgeon University Hospital Coventry and Warwickshire NHS Trust Part 1. Fast Track Surgery for Pancreatic Cancer Part 2.
More informationLONG TERM OUTCOME OF ELECTIVE SURGERY
LONG TERM OUTCOME OF ELECTIVE SURGERY Roberto Persiani Associate Professor Mini-invasive Oncological Surgery Unit Institute of Surgical Pathology (Dir. prof. D. D Ugo) Dis Colon Rectum, March 2000 Dis
More informationUniversity of Groningen. Colorectal Anastomoses Bakker, Ilsalien
University of Groningen Colorectal Anastomoses Bakker, Ilsalien IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationRobotic Ventral Rectopexy
Robotic Ventral Rectopexy What is a robotic ventral rectopexy? The term rectopexy refers to an operation in which the rectum (the part of the bowel nearest the anus) is put back into its normal position
More informationEnhanced Recovery After Surgery (ERAS)
Enhanced Recovery After Surgery (ERAS) Brad White, D.O. Anesthesiology Residency Program Director Oklahoma State University Medical Center Assistant Clinical Professor of Anesthesiology Oklahoma State
More informationPer-Jonas Blind, Bodil Andersson, Bobby Tingstedt, Magnus Bergenfeldt, Roland Andersson, Gert Lindell, Christian Sturesson
2326 LIVER Per-Jonas Blind, Bodil Andersson, Bobby Tingstedt, Magnus Bergenfeldt, Roland Andersson, Gert Lindell, Christian Sturesson Department of Surgery, Clinical Sciences Lund, Skåne University Hospital
More informationThe Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5122-5129 Enhanced Recovery Program (ERP) versus Traditional care after Elective Left Side Colorectal Cancer Surgery Ahmad Aboelkassem
More informationAnalgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital
Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic
More informationFast Track Colorectal Surgery A new era of perioperative care. Jauch, LMU Grosshadern,, Munich
Fast Track Colorectal Surgery A new era of perioperative care P. Rittler,, Karl-Walter Jauch, LMU Grosshadern,, Munich FAST Track = ERAS(Enhanced Enhanced Recovery After Surgery) ) = Multimodal Rehabilitation
More informationPrimary Care Constipation Guidelines. Version 1 November 2016
Primary Care Constipation Guidelines Version 1 November 2016 VERSION CONTROL Version Date Amendments made Version 1 November 2016 New guideline Contents 1. Management of constipation in adults: acute and
More informationAchieving 23 hour hospital stay after colorectal resection. Professor Tim Rockall, Guildford, UK
Achieving 23 hour hospital stay after colorectal resection Professor Tim Rockall, Guildford, UK History Outcomes from open colorectal surgery 10 to 14 days in hospital 10% wound infection 2-10%+ anastomotic
More informationRECENT ADVANCES IN ANALGESIA
4th ERAS UK Conference RECENT ADVANCES IN ANALGESIA Dr William J Fawcett Royal Surrey County Hospital, Guildford University of Surrey, Guildford November 14th 2014 Conflict of interests Paid honoraria
More informationEmergency thoracic surgery. Tim Batchelor Department of Thoracic Surgery Bristol Royal Infirmary
Emergency thoracic surgery Tim Batchelor Department of Thoracic Surgery Bristol Royal Infirmary Introduction What is emergency thoracic surgery? How is the non-elective patient disadvantaged? Enhanced
More informationConstipation An Overview. Definition Physiology of GI tract Etiology Assessment Treatment
CONSTIPATION Constipation An Overview Definition Physiology of GI tract Etiology Assessment Treatment Definition Constipation = the infrequent passage of hard feces Definition of Infrequent The meaning
More informationEnhanced Recovery after Surgery Guideline
Administrative Office: 600 University Ave, 449 Toronto, ON M5G 1X5 T: 416.586.4800 x8534 F: 416.586.8644 E: epearsall@mtsinai.on.ca W: www.bpigs.ca Steering Committee Robin McLeod, Chair Mount Sinai Hospital
More informationSmall Bowel and Colon Surgery
Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions
More informationRole of Alvimopan (Entereg) in Gastrointestinal Recovery And Hospital Length of Stay After Bowel Resection
Role of Alvimopan (Entereg) in Gastrointestinal Recovery And Hospital Length of Stay After Bowel Resection Shan Wang, PharmD, RPh; Neal Shah, PharmD Candidate; Jessin Philip, PharmD, RPh; Tom Caraccio,
More informationEFFECT OF AN ENHANCED RECOVERY AFTER SURGERY PROGRAM ON OPIOID USE AND PATIENT-REPORTED OUTCOMES
EFFECT OF AN ENHANCED RECOVERY AFTER SURGERY PROGRAM ON OPIOID USE AND PATIENT-REPORTED OUTCOMES Obstetrics & Gynecology Vol. 132, No. 2, August 2018 KUSMW OBGYN Journal Club Thomas Greaves, MD, PGY4 August
More informationA Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery
A Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery Tripurari Mishra MD, Deepa Bhat MD, Mina Saeed MD, Jan Kaminski MD, Mihaela Banulescu
More informationBJF Acute Pain Team Formulary Group
Title Analgesia Guidelines for Acute Pain Management (Adults) in BGH Document Type Issue no Clinical guideline Clinical Governance Support Team Use Issue date April 2013 Review date April 2015 Distribution
More informationNasogastric Tube Decompression in Stomach and Small Bowel Surgery
Original Article Nasogastric Tube Decompression in Stomach and Small Bowel Surgery Pokharel N,* Adhikari S,** *Resident, ** Professor, NAMS Bir Hospital, Kathmandu, Nepal ABSTRACT: INTRODUCTION: The use
More informationColorectal Clinical Pathways: A Method of Improving Clinical Outcome?
Original Article Colorectal Clinical Pathways: A Method of Improving Clinical Outcome? Jane J.Y. Tan, Angel Y.Z. Foo and Denis M.O. Cheong, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
More informationCOLORECTAL RESECTIONS
COLORECTAL RESECTIONS What is a colorectal (bowel) resection? Surgery to remove a part of the large bowel is called a resection. Different parts of the colon require different operations and have different
More informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.3 Nutritional Support in the Perioperative Period Ken Fearon Learning Objectives Understand the principles behind nutritional care for
More informationClick to edit Master subtitle style
Does Enhanced Recovery Improve Outcomes? Click to edit Master subtitle style Kaare Weber, MD Director of Surgery Associate Medical Director, Surgery A MEMBER OF THE MONTEFIORE HEALTH SYSTEM mes? Click
More informationA high-volume surgical unit experience with enhanced recovery after surgery (ERAS)
A high-volume surgical unit experience with enhanced recovery after surgery (ERAS) Catalina Mosquera, Nicholas J. Koutlas, Nasreen A. Vohra, Emmanuel E. Zervos, Timothy L. Fitzgerald East Carolina University,
More informationFTS Oesophagectomy: minimal research to date 3,4
Fast Track Programme in patients undergoing Oesophagectomy: A Single Centre 5 year experience Sullivan J, McHugh S, Myers E, Broe P Department of Upper Gastrointestinal Surgery Beaumont Hospital Dublin,
More informationImpact of Preoperative Bowel Preparation on the Risk of Clostridium Difficile after Colorectal Surgery: A Propensity Weighted Analysis
Impact of Preoperative Bowel Preparation on the Risk of Clostridium Difficile after Colorectal Surgery: A Propensity Weighted Analysis Ebram Salama, MD PGY-3 General Surgery Sir Mortimer B. Davis Jewish
More informationKaren Lok Man Tung, Michael Ka Wah Li. Introduction
Original Article Page 1 of 5 Hybrid natural orifice transluminal endoscopic surgery colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors: intermediate follow up of a randomized
More informationColorectal Liver Metastases Metachronous
Colorectal Liver Metastases Metachronous Professor Rowan Parks Professor of Surgical Sciences University of Edinburgh No disclosures Natural History of Unresected Untreated Colorectal Metastases Year N
More informationRepeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease
ORIGINAL ARTICLE pissn 2234-778X eissn 2234-5248 J Minim Invasive Surg 2018;21(1):38-42 Journal of Minimally Invasive Surgery Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic
More informationWith joy and great relief
Ulf Gustafsson All previously published papers and figures were reproduced with permissions from the publishers Published by Karolinska Institutet Printed by Larserics Digital Print AB Ulf Gustafsson,
More informationElderly Man With Chronic Constipation
Elderly Man With Chronic Constipation Linda Nguyen, MD Director, Neurogastroenterology and Motility Clinical Assistant Professor Stanford University Overview Normal bowel function Defining Constipation:
More informationPatient Presentation. 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201
Patient Presentation 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201 CT shows: Thickening of the right hemidiaphragm CT shows: Fluid in the right paracolic sulcus CT shows: Large
More informationEnhanced Recovery After Surgery: Where Do Pharmacists Come In?
Enhanced Recovery After Surgery: Where Do Pharmacists Come In? Melinda C. Joyce, Pharm.D., FAPhA, FACHE Vice President, Corporate Support Services Med Center Health Bowling Green, Kentucky Annual Meeting
More informationPostoperative pain management: Analgesics, algorithms and patient activation
Postoperative pain management: Analgesics, algorithms and patient activation Alfred Deakin Prof. Mari Botti Deakin University/Epworth HealthCare Victorian Perioperative Nurses Group 60 th State Conference,
More informationOpioid constipation treatment dulcolax
P ford residence southampton, ny Opioid constipation treatment dulcolax Posts about how to relieve constipation instantly written by gbrese1958. Official Web site for MOVANTIK (naloxegol) tablets, for
More informationNursing Management Plan Small or large bowel
Nursing Management Plan Small or large bowel Highlight the procedure/s and add other details: Open / Laparoscopic Assisted Hemicolectomy / Right / Left / Extended Sigmoid Colectomy / Transverse Colectomy
More informationMotility Disorders. Pelvic Floor. Colorectal Center for Functional Bowel Disorders (N = 701) January 2010 November 2011
Motility Disorders Pelvic Floor Colorectal Center for Functional Bowel Disorders (N = 71) January 21 November 211 New Patients 35 3 25 2 15 1 5 Constipation Fecal Incontinence Rectal Prolapse Digestive-Genital
More information